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Journal of Vascular Surgery. Venous and... Mar 2020Venous thromboembolism (VTE) is a common disease with potentially devastating and long-term sequelae, such as pulmonary embolism and post-thrombotic syndrome (PTS).... (Review)
Review
OBJECTIVE
Venous thromboembolism (VTE) is a common disease with potentially devastating and long-term sequelae, such as pulmonary embolism and post-thrombotic syndrome (PTS). Given the mortality risk, prevalence of VTE, and limited access to diagnostic imaging, clinically relevant biomarkers for diagnosis and prognostication are needed. Therefore, this review aimed to summarize the data on clinically applicable biomarkers that best indicate acute VTE and chronic PTS.
METHODS
We reviewed the medical and scientific literature from 2001 to 2019 for VTE biomarkers. Randomized controlled trials, meta-analyses, and review articles were included. Primary basic research papers with no clinical applicability, opinion papers, institutional guidelines, and case reports were excluded.
RESULTS
We highlight the diagnostic value of D-dimer alongside other promising biomarkers, including cellular adhesion molecules, P-selectin, cytokines (interleukins 6 and 10), fibrin monomer complexes, and coagulation factors (factor VIII).
CONCLUSIONS
High-sensitivity D-dimer remains the most clinically established VTE biomarker. Current research endeavors are under way to identify more precise biomarkers of VTE and PTS.
Topics: Animals; Biomarkers; Fibrin Fibrinogen Degradation Products; Humans; Inflammation Mediators; Postthrombotic Syndrome; Predictive Value of Tests; Prognosis; Risk Factors; Venous Thromboembolism; Venous Thrombosis
PubMed: 32067731
DOI: 10.1016/j.jvsv.2019.09.008 -
BMC Emergency Medicine Oct 2021It remains controversial whether to include calf veins in the initial ultrasound evaluation of suspected deep venous thrombosis (DVT). We sought to investigate the...
BACKGROUND
It remains controversial whether to include calf veins in the initial ultrasound evaluation of suspected deep venous thrombosis (DVT). We sought to investigate the frequency and clinical characteristics of isolated calf DVT.
MATERIALS AND METHODS
In this retrospective analysis, we investigated a cohort of 596 patients (median age 69 years, 52.3% women) who had been imaged with complete lower extremity venous duplex ultrasound for suspected acute DVT. Radiology reports were analyzed for the presence and localization of DVT. Clinical information was collected from patients' electronic charts.
RESULTS
DVT was found in 157 patients (26.3%), of which 74 patients (47.1%) had isolated calf DVT. Isolated calf DVTs were located in the posterior tibial veins (22 patients, 29.7%), peroneal veins (41 patients, 55.4%) and muscle veins (19 patients, 25.7%). There were no differences in age or sex between patients with isolated calf DVT and patients with proximal DVT. Isolated calf DVT was more commonly associated with leg pain (52.7% vs. 33.7%, p = 0.0234) and less commonly associated with subjective leg swelling (35.1% vs. 55.4%, p = 0.0158) and objectively measured difference in leg circumference (23% vs. 39.8%, p = 0.0268). D-Dimers were significantly lower in patients with isolated lower leg DVT (median 2.3 vs. 6.8 mg/L, p < 0.0001) compared to patients with proximal DVT.
CONCLUSIONS
Isolated calf DVT represents approximately half of DVT cases and has different clinical characteristics than proximal DVT.
Topics: Acute Disease; Aged; Female; Humans; Leg; Male; Retrospective Studies; Ultrasonography; Venous Thrombosis
PubMed: 34717549
DOI: 10.1186/s12873-021-00516-1 -
European Journal of Vascular and... Apr 2022To develop a large animal model of iliocaval deep venous thrombosis (DVT), which enables development and evaluation of interventional management and existing imaging...
OBJECTIVE
To develop a large animal model of iliocaval deep venous thrombosis (DVT), which enables development and evaluation of interventional management and existing imaging modalities.
METHODS
The experimental protocol consisted of a total endovascular approach. Pigs were percutaneously accessed through the right internal jugular and bilateral femoral veins. Three balloon catheters were inflated to induce venous stasis in the infrarenal inferior vena cava (IVC) and bilateral common iliac veins (CIVs). Hypercoagulability was induced by injecting 10 000 IU of thrombin. After 2.5 hours, the balloon catheters were removed before animal recovery. After seven, 14, 21, 28, or 35 days, animals were euthanised; the IVC and CIV were harvested en bloc, cross sectioned and prepared for histological examination. Multimodal imaging was performed before and after thrombus creation, and before animal euthanasia.
RESULTS
Thirteen female domestic pigs with a mean weight of 59.3 kilograms were used. The mean maximum IVC diameter and area were 16.4 mm and 1.2 cm, respectively. The procedure was successful in 12 animals with occlusive venous thrombosis in the region of interest on immediate post-operative magnetic resonance venography and a mean thrombus volume of 19.8 cm. Clinical pathology results showed platelet consumption, D dimer increase, and inflammatory response. Histological evaluation demonstrated a red cell, fibrin, and platelet rich thrombus on day 1, with progressive inflammatory cell infiltration from day 7. Collagen deposition appeared in week 2 and neovascularisation in week 3.
CONCLUSION
Endovascular occlusion combined with thrombin infusion is a reliable minimally invasive approach to produce acute and subacute DVT in a large animal model.
Topics: Animals; Disease Models, Animal; Endovascular Procedures; Female; Humans; Iliac Vein; Stents; Swine; Thrombin; Treatment Outcome; Vascular Patency; Vena Cava, Inferior; Venous Thrombosis
PubMed: 35272950
DOI: 10.1016/j.ejvs.2021.12.022 -
Acta Medica Indonesiana Oct 2022Thromboembolism events, either venous (VTE) or arterial thromboembolism (ATE) remain a highly prevalent complication in cancer patients. Thrombosis is a leading cause of...
Thromboembolism events, either venous (VTE) or arterial thromboembolism (ATE) remain a highly prevalent complication in cancer patients. Thrombosis is a leading cause of death, contributor to significant morbidity, the reason of delayed cancer treatment, leading to increased cancer financing and expenses. Both cancer and its treatment are recently found to be related to vascular inflammation through the induction of tissue factor (TF) expression and promoting a procoagulant state which triggers the activation of coagulation system. Several risk factors may also coexist such as dehydration, immobilization, smoking, obesity, previous DVT, etc. Even in patients with asymptomatic deep vein thrombosis (DVT), they have a three-fold increase in mortality. The high morbidity and mortality of VTE raises the need for thromboprophylaxis to reduce the incidence of overt thrombosis, albeit against its possible side effects related to anticoagulant prescription. This article highlighted the clinical perspectives for thromboprophylaxis while counting on the risk stratification in a particular cancer patient.
Topics: Humans; Anticoagulants; Venous Thrombosis; Venous Thromboembolism; Thrombosis; Risk Factors; Pulmonary Embolism; Neoplasms
PubMed: 36624716
DOI: No ID Found -
Scientific Reports May 2023In view of the current debate about the relationship between lipids and deep venous thrombosis (DVT) in clinical studies, a two-sample Mendelian randomization (MR) study...
In view of the current debate about the relationship between lipids and deep venous thrombosis (DVT) in clinical studies, a two-sample Mendelian randomization (MR) study was conducted to clarify the effects of five circulating lipids (apolipoprotein A1, apolipoprotein B, low-density lipoprotein, high-density lipoprotein and triglycerides) on DVT from the perspective of genetic inheritance. Five lipids (exposure) were analysed by MR with DVT (outcome) from two different data sources. For the analysis, we used inverse variance weighting and a weighted mode, weighted median, simple mode and MR-Egger regression to analyse the effect of circulating lipids on DVT. In addition, we used the MR-Egger intercept test, Cochran's Q test and "leave-one-out" sensitivity analysis to evaluate horizontal multiplicity, heterogeneity and stability, respectively, in the analysis. In the analysis, the two-sample Mendelian randomization analysis of five common circulating lipids and DVT showed that common circulating lipids had no causal effect on DVT, which is somewhat inconsistent with the findings of many published observational studies. Based on our results, our two-sample MR analysis failed to detect a statistically significant causal relationship between five common circulating lipids and DVT.
Topics: Humans; Mendelian Randomization Analysis; Apolipoproteins B; Lipoproteins, HDL; Lipoproteins, LDL; Venous Thrombosis; Genome-Wide Association Study
PubMed: 37156934
DOI: 10.1038/s41598-023-34726-3 -
Circulation Nov 2022The efficacy and safety of prophylactic full-dose anticoagulation and antiplatelet therapy in critically ill COVID-19 patients remain uncertain. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The efficacy and safety of prophylactic full-dose anticoagulation and antiplatelet therapy in critically ill COVID-19 patients remain uncertain.
METHODS
COVID-PACT (Prevention of Arteriovenous Thrombotic Events in Critically-ill COVID-19 Patients Trial) was a multicenter, 2×2 factorial, open-label, randomized-controlled trial with blinded end point adjudication in intensive care unit-level patients with COVID-19. Patients were randomly assigned to a strategy of full-dose anticoagulation or standard-dose prophylactic anticoagulation. Absent an indication for antiplatelet therapy, patients were additionally randomly assigned to either clopidogrel or no antiplatelet therapy. The primary efficacy outcome was the hierarchical composite of death attributable to venous or arterial thrombosis, pulmonary embolism, clinically evident deep venous thrombosis, type 1 myocardial infarction, ischemic stroke, systemic embolic event or acute limb ischemia, or clinically silent deep venous thrombosis, through hospital discharge or 28 days. The primary efficacy analyses included an unmatched win ratio and time-to-first event analysis while patients were on treatment. The primary safety outcome was fatal or life-threatening bleeding. The secondary safety outcome was moderate to severe bleeding. Recruitment was stopped early in March 2022 (≈50% planned recruitment) because of waning intensive care unit-level COVID-19 rates.
RESULTS
At 34 centers in the United States, 390 patients were randomly assigned between anticoagulation strategies and 292 between antiplatelet strategies (382 and 290 in the on-treatment analyses). At randomization, 99% of patients required advanced respiratory therapy, including 15% requiring invasive mechanical ventilation; 40% required invasive ventilation during hospitalization. Comparing anticoagulation strategies, a greater proportion of wins occurred with full-dose anticoagulation (12.3%) versus standard-dose prophylactic anticoagulation (6.4%; win ratio, 1.95 [95% CI, 1.08-3.55]; =0.028). Results were consistent in time-to-event analysis for the primary efficacy end point (full-dose versus standard-dose incidence 19/191 [9.9%] versus 29/191 [15.2%]; hazard ratio, 0.56 [95% CI, 0.32-0.99]; =0.046). The primary safety end point occurred in 4 (2.1%) on full dose and in 1 (0.5%) on standard dose (=0.19); the secondary safety end point occurred in 15 (7.9%) versus 1 (0.5%; =0.002). There was no difference in all-cause mortality (hazard ratio, 0.91 [95% CI, 0.56-1.48]; =0.70). There were no differences in the primary efficacy or safety end points with clopidogrel versus no antiplatelet therapy.
CONCLUSIONS
In critically ill patients with COVID-19, full-dose anticoagulation, but not clopidogrel, reduced thrombotic complications with an increase in bleeding, driven primarily by transfusions in hemodynamically stable patients, and no apparent excess in mortality.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT04409834.
Topics: Humans; COVID-19; Critical Illness; Thrombosis; Clopidogrel; Hemorrhage; Anticoagulants; Venous Thrombosis; Platelet Aggregation Inhibitors; Treatment Outcome
PubMed: 36036760
DOI: 10.1161/CIRCULATIONAHA.122.061533 -
American Family Physician Oct 2021Air travel is generally safe, but the flight environment poses unique physiologic challenges such as relative hypoxia that may trigger adverse myocardial or pulmonary... (Review)
Review
Air travel is generally safe, but the flight environment poses unique physiologic challenges such as relative hypoxia that may trigger adverse myocardial or pulmonary outcomes. To optimize health outcomes, communication must take place between the traveler, family physician, and airline carrier when there is any doubt about fitness for air travel. Travelers should carry current medications in their original containers and a list of their medical conditions and allergies; they should adjust timing of medications as needed based on time zone changes. The Hypoxia Altitude Simulation Test can be used to determine specific in-flight oxygen requirements for patients who have pulmonary complications or for those for whom safe air travel remains in doubt. Patients with pulmonary conditions who are unable to walk 50 m or for those whose usual oxygen requirements exceed 4 L per minute should be advised not to fly. Trapped gases that expand at high altitude can cause problems for travelers with recent surgery; casting; ear, nose, and throat issues; or dental issues. Insulin requirements may change based on duration and direction of travel. Travelers can minimize risk for deep venous thrombosis by adequately hydrating, avoiding alcohol, walking for 10 to 15 minutes every two hours of travel time, and performing seated isometric exercises. Wearing compression stockings can prevent asymptomatic deep venous thrombosis and superficial venous thrombosis for flights five hours or longer in duration. Physicians and travelers can review relevant pretravel health information, including required and recommended immunizations, health concerns, and other travel resources appropriate for any destination worldwide on the Centers for Disease Control and Prevention travel website.
Topics: Air Travel; Health Status; Humans; Hypoxia; Risk Factors; Venous Thrombosis
PubMed: 34652099
DOI: No ID Found -
Scientific Reports Jan 2023Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous...
Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous studies on enhancing efficiency of computer-aided diagnosis, but clinical diagnostic approaches have never been considered. In this study, we evaluated the performance of an artificial intelligence (AI) algorithm in the detection of iliofemoral deep venous thrombosis on computed tomography angiography of the lower extremities to investigate the effectiveness of using the clinical approach during the feature extraction process of the AI algorithm. To investigate the effectiveness of the proposed method, we created synthesized images to consider practical diagnostic procedures and applied them to the convolutional neural network-based RetinaNet model. We compared and analyzed the performances based on the model's backbone and data. The performance of the model was as follows: ResNet50: sensitivity = 0.843 (± 0.037), false positives per image = 0.608 (± 0.139); ResNet152 backbone: sensitivity = 0.839 (± 0.031), false positives per image = 0.503 (± 0.079). The results demonstrated the effectiveness of the suggested method in using computed tomography angiography of the lower extremities, and improving the reporting efficiency of the critical iliofemoral deep venous thrombosis cases.
Topics: Humans; Artificial Intelligence; Venous Thrombosis; Pulmonary Embolism; Angiography; Lower Extremity
PubMed: 36653367
DOI: 10.1038/s41598-022-25849-0 -
Journal of Thrombosis and Haemostasis :... Jan 2021Essentials Venous thrombosis (VT) risk and coagulation factor levels increase with age. We studied the association between levels of procoagulant factors and the risk of...
Essentials Venous thrombosis (VT) risk and coagulation factor levels increase with age. We studied the association between levels of procoagulant factors and the risk of a first VT in the elderly. Higher levels of factors VIII, IX, and XI, but not prothrombin, were associated with the risk of VT. Similar risk patterns were observed for provoked and unprovoked VT and for deep vein thrombosis and pulmonary embolism separately. ABSTRACT: Background Venous thrombosis (VT) incidence increases markedly with age. Coagulation factors are also positively associated with age. Objective To study whether higher levels of coagulation factors II (prothrombin), VIII, IX, and XI are associated with risk of a first VT in the elderly. Methods Four hundred and one patients and 431 control subjects aged 70 and older were included in the Age and Thrombosis, Acquired and Genetic risk factors in the Elderly (AT-AGE) study. Blood was collected 1 year after the event in patients and in all control subjects for measurement of coagulation factors. To assess the risk of VT, odds ratios (ORs) were calculated after stratification of coagulation factors in quartiles and at the 90th percentile, adjusting for potential confounders (age, sex, body mass index, and study center). Results Mean age was 78 years (range: 70-100 years). The ORs of VT for factors in the top quartile compared with the lowest quartile were 4.5 (95% confidence interval [CI]:2.7-7.3) for factor VIII, 2.4 (95% CI:1.1-5.2) for factor IX, and 1.7 (95% CI:1.0-2.9) for factor XI. High prothrombin was not associated with an increased VT risk. There was no dose-response association between the number of high coagulation factors and VT risk. The population attributable risk (PAR) of VT was 37.6%, 23.3%, and 12.4% for factor VIII, IX, and XI, respectively. Conclusion In this study of the elderly, higher factors VIII, IX, and XI but not prothrombin, were positively associated with the risk of VT.
Topics: Aged; Aged, 80 and over; Case-Control Studies; Factor IX; Factor XI; Humans; Risk Factors; Venous Thrombosis
PubMed: 33090602
DOI: 10.1111/jth.15127 -
BioMed Research International 2021Deep venous thrombosis (DVT) is a common complication in patients with lower extremity fractures, causing delays in recovery short-term and possible impacts on quality...
Deep venous thrombosis (DVT) is a common complication in patients with lower extremity fractures, causing delays in recovery short-term and possible impacts on quality of life long-term. Early prediction and prevention of thrombosis can effectively reduce patient pain while improving outcomes. Although research on the risk factors for thrombosis is prevalent, there is a stark lack of clinical predictive models for DVT occurrence specifically in patients with lower limb fractures. In this study, we aim to propose a new thrombus prediction model for lower extremity fracture patients. Data from 3300 patients with lower limb fractures were collected from Wuhan Union Hospital and Hebei Third Hospital, China. Patients who met our inclusion criteria were divided into a thrombosis and a nonthrombosis group. A multivariate logistic regression analysis was carried out to identify predictors with obvious effects, and the corresponding formulas were used to establish the model. Model performance was evaluated using a discrimination and correction curve. 2662 patients were included in the regression analysis, with 1666 in the thrombosis group and 996 in the nonthrombosis group. Predictive factors included age, Body Mass Index (BMI), fracture-fixation types, energy of impact at the time of injury, blood transfusion during hospitalization, and use of anticoagulant drugs. The discriminative ability of the model was verified using the C-statistic (0.676). For the convenience of clinical use, a score table and nomogram were compiled. Data from two centers were used to establish a novel thrombus prediction model specific for patients with lower limb fractures, with verified predictive ability.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Body Mass Index; Child; Female; Fracture Fixation; Fractures, Bone; Hospitalization; Humans; Leg; Male; Middle Aged; Models, Statistical; Multivariate Analysis; Nomograms; Predictive Value of Tests; Retrospective Studies; Risk; Risk Factors; Thrombosis; Treatment Outcome; Venous Thrombosis; Young Adult
PubMed: 34258284
DOI: 10.1155/2021/9930524